Pre-Screening Application Date* Month Day Year Prospect's Name* First Middle Last Date of Birth* Month Day Year SWIC ID#Primary Phone*Secondary PhoneEmail* Address* Street Address City ZIP / Postal Code Sex* Female Male Non-Binary Prefer not to answer Gender* he/him/his she/her/hers they/their/theirs Race* Native American/Alaskan Native Asian Black/African-American Hawaiian/Pacific Islander Hispanic White Prefer not to answer Military Status* None Active Recently Separated Veteran Retired Veteran Disabled Veteran War/Combat Veteran Dishonorable Discharge Marital Status* Single Married Divorced Other Are you interested in a career in the construction industry?* Yes No Do you have the ability to attend a 10 week training program?* Yes No Do you have a high school diploma or equivalency (GED)?* Yes No What is your highest level of education?* High School Some College Associates Bachelors Master Other Do you have 1 year of high school level Algebra 1 or equivalent with a grade of "C" or better?* Yes No Are you able to participate and understand classroom instruction given in the English language?* Yes No Have you participated in a pre-apprenticeship training before?* Yes No Are you 18 years of age or older?* Yes No Are you an Illinois resident?* Yes No Are you authorized to work in the United States?* Yes No Do you have a valid drivers license?* Yes No Do you have restrictions preventing you from getting a valid drivers license?* Yes No How will you get to a worksite/training?* Own Car Get a Ride Bus Train/Subway No Reliable Transportation Other Some employers will complete a background check for new employees. Please check all the following that applies to your situation:* I am registered in the sex offender registry. I have a violent felony conviction. I have a nonviolent felony conviction. I have a misdemeanor conviction (excluding traffic violations) within the past 7 years. I have been on probation in the last 10 years (excluding traffic violations). None of the above applies to me. Some employers will require you to be drug free for some apprenticeships. In those cases they will require you to pass a drug test showing no substances in your system for the previous 30 to 120 days. Will you be able to pass a drug test?* Yes, I am drug free and can pass a drug test. Yes, I have been drug free for at least 30 days. Yes, I am willing to make changes to pass a drug test. Yes, I want to be able to pass a drug test, but I need help I am not interested in careers that require a drug test. Are you willing to take a drug test?* Yes No Have you worked in construction before?* Yes No What is your current employment status?* I have not worked before, this is my first job. I am employed and currently working. I am employed but have received a notification of termination/layoff. I am unemployed and have been actively looking for work I am unemployed but have not been actively looking for work. Who is your most recent employer?Employer Name:*Start Date* Month Day Year End Date (if applicable) Month Day Year Job Title*Employer Full Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job Duties*Hours worked per week*Are you currently employed here?* Yes No Does this job meet your needs?* Yes No Why or why not?*Reason for leaving?*Was this your primary employment?* Yes No Were you self-employed?* Yes No How did you hear about this program?* Email Social Media Family/Friends SWIC Career Services American Job Center Website Nonprofit/Faith based organization Mailings Newspaper/Magazine Radio TV Other CAPTCHA
